Healthcare Provider Details

I. General information

NPI: 1760981906
Provider Name (Legal Business Name): YANA KOFMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 BROADWAY STE 103
WOODMERE NY
11598-1227
US

IV. Provider business mailing address

961 BROADWAY STE 102
WOODMERE NY
11598-1733
US

V. Phone/Fax

Practice location:
  • Phone: 917-524-7663
  • Fax:
Mailing address:
  • Phone: 917-524-7663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number011327
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: